CDIS Blog
Many seniors enjoy warm weather living year-round by maintaining a dual residence or living for part of the year in two different states. The dual residence is nothing new, and “snowbirds” have been fleeing to southern states in winter for generations. But how does dual residence impact your Medicare options, will you still be covered if you live in two states? Here’s some guidance on Medicare and what you should know if you head south for the winter.
Original Medicare Benefits Work Anywhere Within the United States
With Original Medicare (Part A and Part B), you can travel anywhere within the United States and still be covered—as long as you choose providers who accept Medicare. This is good news for anyone planning to spend part of the year in one state and part of the year in another. Whether you are in Florida or Michigan, any doctor or hospital that accepts assignments will honor your Part A and Part B benefits.
While in most cases, Medicare does not cover care you receive outside of the country, it does include:
All 50 states
The District of Columbia
Puerto Rico
The Virgin Islands
Guam, American Samoa
The Northern Mariana Islands
Medicare Supplement Insurance Is Not Restricted By Service Networks
Like Original Medicare, Medicare Supplement Insurance, or Medigap, does not rely on service networks, and as long as the doctor or hospital you choose accepts Medicare, you’re covered. As a senior with homes in two states, you can travel freely with the peace of mind and confidence that when you need medical care, you can get it and your Medicare Supplement Insurance plan will be applied. Note: if you are a dual resident considering Medigap, be sure to compare policies offered by each state to learn about any differences that may impact your coverage.
Medicare Advantage and Part D Plans Don’t Always Extend Across State Lines
For Medicare Part C and D, the rules for out-of-state coverage are different and your plan may not cover your care while you travel within the United States. With many plans, you need to be a permanent resident of the state where you originally enrolled and you must live in the service area of your plan. In some cases, you can receive out-of-network care, but it will likely cost you more money. In addition, your plan may have specific rules you need to follow, such as needing prior authorization before receiving care that can impact your coverage. With all Medicare plans, Original Medicare, Medicare Advantage, and Medigap, you are covered in any state if you need emergency medical care or urgent care out of network.
Resources:
https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/switching-plans/switch-medigap-.html#collapse-2514
https://www.medicare.gov/sign-up-change-plans/decide-how-to-get-medicare/original-medicare/how-original-medicare-works.html#collapse-3111
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CDIS Blog
Whether or not you take prescription drugs, you may want to consider your options carefully when it comes to joining Medicare Part D. Unless you have other, creditable coverage offered through work or a union, going without prescription drug benefits may end up costing you money. Do you have to join Medicare Part D to avoid extra fees? Part D coverage is optional, but without the right guidance, you could end up paying a higher premium from a late enrollment penalty. Here’s some information on Part D coverage and what you should know if you are approaching your Initial Enrollment Period.
How to Avoid the Part D Penalty
Joining Medicare Part D, or prescription drug coverage, is optional. However, joining late may trigger a penalty. How do you avoid the Part D penalty?
Join Part D when you are first eligible, during your Initial Enrollment period.
Maintain creditable coverage (other prescription drug coverage) through an employer, union, or other health insurance provider.
If you do not currently have prescription drug benefits through an employer or other source, the best time to join Medicare Part D is when you are first eligible, during your Initial Enrollment period. Even if you do not need medications now, joining during Initial Enrollment ensures you avoid paying a late enrollment penalty.
Not everyone needs to join Medicare Part D when they are first eligible, and many seniors delay enrollment without paying a penalty. Many employer-provided health insurance plans offer drug coverage that is considered “creditable” by Medicare.
If you do have drug benefits, as long as you are covered, you do not need to join. However, if you lose coverage (employer benefits end or COBRA ends) you only have a certain amount of time to join Part D without penalty.
Your health insurance provider will let you know if your coverage is creditable. Be sure to keep this documentation safe as you will need to show it to Medicare when you are ready to join Part D. Without proof, you may end up paying a late enrollment penalty.
If You are Penalized, Here’s How to Calculate Your Premium
If you go without a Medicare prescription drug plan (Part D) or other creditable coverage for 63 days or more after your Initial Enrollment period ends, you may owe a late enrollment penalty. Penalties are calculated by multiplying the Part D premium amount by the number of full months you went without Part D or creditable drug coverage.
Resources:
Part D Penalty: https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html
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CDIS Blog
Prescription drug benefits are often included as part of an employer-provided health insurance plan. If you are one of thousands of seniors relying on coverage through work and expect to use your plan’s drug benefits, do you have ‘creditable coverage’? As a Medicare-eligible policyholder, you have the right to know whether or not your current drug coverage meets the standard Medicare prescription drug coverage, and is considered ‘creditable’.If your current prescription drug benefits are provided through an employer, union, or another source, understanding what ‘creditable coverage’ means and how it applies to you will help you make an informed decision—potentially saving you money. The good news? All companies offering prescription drug coverage are required by law to notify you about the status of benefits and whether or not your drug plan meets or exceeds the standard Medicare Part D Prescription Drug plan.
Creditable Coverage
For prescription drug coverage to be creditable, the plan must expect to pay (on average) as much as the standard Medicare prescription drug coverage. How is this determined?
Creditable coverage does the following:
Provides coverage for brand name and generic prescriptions.
Provides reasonable access to retail providers.
Pays an average of at least 60 percent of a participant’s drug expenses.
Satisfies at least one from below:
No annual benefit maximum.
An expectation is that the amount payable by the plan will be at least 2,000 annually.
For integrated coverage: No more than $250 deductible per year, no annual benefit maximum, and no less than a $1,000,000 lifetime combined benefit maximum.
Why It Matters
Of course, there’s a good reason why it makes sense to maintain creditable prescription drug coverage. Medicare beneficiaries who decide not to sign up for Part D prescription drug coverage when they are first eligible, but enter the program late often have to pay more. People signing up late for Medicare Part D without creditable drug coverage may be subject to a 1 percent monthly premium penalty for late enrollment.
However, if you have drug benefits through an employer—and it’s creditable—you can stay with your current plan instead of enrolling in Medicare Part D and avoid paying higher prices when you do enroll. In other words, as long as your current drug benefits are as good as Medicare, or ‘creditable’, you can continue to use them and will not pay higher prices when you decide to enroll in Part D at a later date.
What You Should Know
As long as you maintain drug coverage through an employer or union, you should receive a notice by mail each September informing you whether or not your coverage is ‘creditable’. Be sure to keep this documentation—you may need it should you decide to move to a Medicare drug plan later.
Resources:
https://www.cms.gov/medicare/prescription-drug-coverage/creditablecoverage/index.html
https://www.cms.gov/medicare/prescription-drug-coverage/creditablecoverage/downloads/whatiscreditablecoverage.pdf
https://www.medicare.gov/forms-help-and-resources/mail-about-medicare/notice-of-creditable-coverage.html
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CDIS Blog
For many seniors, travel is an exciting part of a retirement plan. Whether you’re planning a continuous exploration of faraway lands or a simple one-week trip abroad, foreign travel is a reality for many after leaving the nine-to-five lifestyle behind. But, what about your health care needs? Will your Medicare coverage come with you on your journey? Typically, Original Medicare does not cover health care you receive while traveling outside of the United States. However, some Medicare Supplement plans do.
Foreign Travel Emergency Care
Some plans offer foreign travel coverage—medical benefits as you travel out of the country. The 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa are considered part of the United States—domestic travel, and foreign travel benefits are not necessary. For all other travel outside of the United States, foreign travel emergency care coverage is provided by supplement plans: Plan G, and N. If you purchased Medicare Supplement insurance before 2010, and you have plans E, H, I, or J, your foreign travel benefits will still be valid, even though these plans are no longer offered for sale.
What Is Covered
With any of the above plans, you will have foreign travel emergency care that begins during the first 60 days of your trip. Your supplement plan will pay 80 percent of the billed charges for necessary medical care outside of the U.S. after you pay a $250 deductible. There is a lifetime limit of $50,000 for all foreign travel emergency care. If you’re undecided as to whether or not you should buy coverage, here’s something to think about: Medicare Supplement plans are available with no underwriting only during your Initial Enrollment period. If you think you may be traveling abroad during retirement, you may want to plan by choosing a plan that offers foreign travel benefits.
In Rare Cases, Original Medicare Pays for Foreign Care
Typically, Medicare does not pay for treatment outside of the United States and Medicare Prescription Drug plans do not cover medications purchased abroad. However, in some rare cases, Medicare may pay up to 80 percent for services covered under Original Medicare even while you are out of the country. Note, that foreign hospitals are not required to submit claims to Medicare. More than likely you will need to submit an itemized bill to be reimbursed.
Original Medicare may pay for inpatient care, ambulance services, or dialysis treatment outside of the U.S. if:
You are in the United States when a medical emergency occurs and a foreign hospital is closer than a U.S. hospital.
You are traveling through Canada en route to Alaska and a Canadian hospital is closer than a U.S. hospital.
You are on a ship within territorial waters adjoining lands of the U.S. but within 6 hours of a U.S. port.
You live in the U.S. and have a medical emergency, but a foreign hospital is closer than a U.S. hospital.
Resources:
https://www.medicare.gov/supplement-other-insurance/medigap-and-travel/medigap-and-travel.html
https://www.medicare.gov/coverage/travel-need-health-care-outside-us.html
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CDIS Blog
As a senior age 65 or older, you may be eligible to join a Medicare Advantage plan as an alternative to Original Medicare. A smart, sensible way to get the coverage you need. As long as you live in the plan’s service area, and are enrolled in Medicare Parts A and B, there are times throughout the year when you can enroll. Here is some important enrollment information that can help.
When to Apply
Typically, you can only join a Medicare Advantage plan during certain times throughout the year. Medicare Part C Enrollment periods were created to make it easy for people to get the coverage they need. However, outside of these periods, Medicare often requires that you stay with the plan you have until the following year. Of course, there are exceptions and in some cases, you may apply outside of designated enrollment periods.
It can be confusing with all the different enrollment periods. The good news is, that once you familiarize yourself with the details, it’s easier than ever to secure comprehensive and affordable coverage. Here is a convenient breakdown of each enrollment period.
Initial Enrollment Period
The best time to apply for Medicare Part C is during your Initial Enrollment period, or when you are first eligible to receive Medicare. Every senior has an Initial Enrollment period that begins 3 months before you turn 65 and ends three months after. If you are disabled, your Initial Enrollment period begins 3 months before your 25th month of benefits and ends 3 months after your 25th month of benefits.
Annual Enrollment Period
Once you join Medicare, you can apply for Medicare Part C during Annual Enrollment, which is October 15 through December 7 of each year. During this time, anyone can join, switch, or drop a Medicare Advantage plan. Remember, if you miss the December 7 deadline, you may have to wait until the following year to purchase Medicare Advantage unless you qualify for a special enrollment period.
Special Enrollment Period
Medicare realizes that some situations make it challenging to meet enrollment periods. Special enrollment periods were created to give all seniors the same opportunity.
If you meet one of the following conditions, you may qualify for a special enrollment period:
Change in Residence Moving out of your current plan’s service area or in or out of a nursing home
Lose Your Current Coverage Losing employer-provided coverage or no longer eligible for Medicaid or Extra Help
Your Plan Changes The Current plan is terminated by Medicare
Special enrollment period: https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/special-circumstances/join-plan-special-circumstances.html#collapse-3193
Initial enrollment and Annual enrollment period: https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/when-can-i-join-a-health-or-drug-plan.html#collapse-3190
General information: https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/medicare-advantage-plans.html
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